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HCFA & Timely Filing Requirements

Patient care is the most important aspect of running a medical office and other important details may be overlooked. Frequently, insurance billing isn't prompt due to misplaced paperwork, billing the wrong insurance company or unanswered inquiries from insurers. All insurers have rules about timely billing; the time allowed is different for each insurance company. The Health Care Finance Administration recently announced new guidelines for timely filing of the HCFA 1500 billing form, which affects Medicare billing.

  1. New Rules

    • The recently passed Patient Protection and Affordable Care Act changes the timely filing requirement of the HCFA 1500 form. This is the form providers submit for fee-for-service claims for Medicare patients. The changes shorten the time limits for filing these claims and are meant to cut fraud and waste in the Medicare program.

    Effective Date

    • Section 6404 of the PPACA amended the timely filing requirements to cut the maximum time period for submission of all Medicare FFS claims. The new standard requires that claims be submitted within one calendar year after the date of service. This went into effect Jan. 1, 2010. Claims for services provided before Jan. 1, 2010 must be filed by Dec. 31, 2010. HCFA will reject any claim filed out of the time limits.

    Changes

    • There are other filing requirements for pre-2010 claims. Claims for services furnished before Oct. 1, 2009 must use the system in place before the PPACA timely filing rules. Claims that fall between Oct. 1, 2009 and Dec. 31, 2009 must be submitted by Dec. 31, 2010. Section 6404 allows the Secretary of Health and Human Services to make exceptions to the one-year filing limit, although no exceptions are identified.

      There are several rules for claims with dates of service before Jan. 1, 2010. Claims with dates of service before Oct. 1, 2009 must follow the pre-PPACA timely filing rules. Submission of claims with dates of service from Oct. 1, 2009 through Dec. 31, 2009 also must file by Dec. 31, 2010.

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